Abstract:In order to shed light on genetic and environmental factors contributing to breast cancer health disparities, anonymous data from the cancer registry in Brooklyn, NY and two countries in the Caribbean, have been analyzed and compared. De-identified data were obtained on 3,710 women from three cancer registries in Brooklyn (New York), Guyana, and Trinidad, all having been diagnosed with breast cancer between 1995 and 2007, with follow-up through to early 2009. There was a significant difference in breast cancer… Show more
“…Despite the fact that survival data accuracy for blacks born outside the United States can be problematic, 16 some studies have documented this pattern. 61–64 On the other hand, if Caribbeans living in Florida have higher or even stable cancer mortality rates compared to their counterparts in their countries of origin, then these changes likely reflect true increases in incidence rather than decreases in survival.…”
Introduction
The quantitative intraracial burden of cancer incidence, survival and mortality within black populations in the US is virtually unknown.
Methods
We computed cancer mortality rates of US- and Caribbean-born residents of Florida, specifically focusing on black populations (US, Haiti, Jamaica) and compared them using age-adjusted mortality ratios obtained from Poisson regression models. We compared the mortality of Haitians and Jamaicans residing in Florida to populations in their countries of origin using Globocan.
Results
We analyzed 185,113 cancer deaths from 2008–2012, of which 20,312 occurred in black populations. The overall risk of death from cancer was 2.1 (95% CI: 1.97–2.17) and 1.6 (95% CI: 1.55–1.71) times higher for US-born blacks than black Caribbean men and women, respectively (p<0.001).
Conclusions
Race alone is not a determinant of cancer mortality. Among all analyzed races and ethnicities, including Whites and Hispanics, US-born blacks had the highest mortality rates while black Caribbeans had the lowest. The biggest intraracial difference was observed for lung cancer, for which US-blacks had nearly 4 times greater mortality risk than black Caribbeans. Migration from the islands of Haiti and Jamaica to Florida resulted in lower cancer mortality for most cancers including cervical, stomach, and prostate, but increased or stable mortality for two obesity-related cancers, colorectal and endometrial cancers. Mortality results in Florida suggest that US-born blacks have the highest incidence rate of “aggressive” prostate cancer in the world, rather than Caribbean men.
“…Despite the fact that survival data accuracy for blacks born outside the United States can be problematic, 16 some studies have documented this pattern. 61–64 On the other hand, if Caribbeans living in Florida have higher or even stable cancer mortality rates compared to their counterparts in their countries of origin, then these changes likely reflect true increases in incidence rather than decreases in survival.…”
Introduction
The quantitative intraracial burden of cancer incidence, survival and mortality within black populations in the US is virtually unknown.
Methods
We computed cancer mortality rates of US- and Caribbean-born residents of Florida, specifically focusing on black populations (US, Haiti, Jamaica) and compared them using age-adjusted mortality ratios obtained from Poisson regression models. We compared the mortality of Haitians and Jamaicans residing in Florida to populations in their countries of origin using Globocan.
Results
We analyzed 185,113 cancer deaths from 2008–2012, of which 20,312 occurred in black populations. The overall risk of death from cancer was 2.1 (95% CI: 1.97–2.17) and 1.6 (95% CI: 1.55–1.71) times higher for US-born blacks than black Caribbean men and women, respectively (p<0.001).
Conclusions
Race alone is not a determinant of cancer mortality. Among all analyzed races and ethnicities, including Whites and Hispanics, US-born blacks had the highest mortality rates while black Caribbeans had the lowest. The biggest intraracial difference was observed for lung cancer, for which US-blacks had nearly 4 times greater mortality risk than black Caribbeans. Migration from the islands of Haiti and Jamaica to Florida resulted in lower cancer mortality for most cancers including cervical, stomach, and prostate, but increased or stable mortality for two obesity-related cancers, colorectal and endometrial cancers. Mortality results in Florida suggest that US-born blacks have the highest incidence rate of “aggressive” prostate cancer in the world, rather than Caribbean men.
“…Proportions of obesity (all ages): Asian Indian (2.2%), other (7.2%). No p-value given.Taioli, 2012 [73]Registry-based3,710allPopulationTrinidad & Tobago, Guyana//EthnicityTrinidad: Regression for breast cancer mortality across ethnicity: white (HR 1.3, 95% CI 0.8–1.9), Indian (HR 1.2, 95% CI 1.1–1.4), other/unknown (HR 1.3, 95% CI 1.1–1.5) (ref: black). Guyana: Regression for breast cancer mortality across ethnicity: white (HR 1.1, 95% CI 0.4–2.6), Indian (HR 1.3, 95% CI 1.0–1.6), other/unknown (HR 1.0, 95% CI 0.7–1.5).Torres, 2007 [69]Cross-sectional/25 to 50PopulationCuba/Residence I
/Means (range) of incidence rates per 100,000 are as follows - Pinar del Rio, Havana, Cienfuegos,Villa Clara, Ciego de Avila (≤20.7); Sancti Spiritus, Matanzas, Isla de Juventud (20.8-24.9); Camaguey, Holguin, Granma (25.0-36.8); Santiago de Cuba, Guantanamo, Las Tunas (≥36.9).…”
Section: Resultsmentioning
confidence: 99%
“…There were 75 inequality relationships reported: 59 on breast cancer risk factors, 13 on breast cancer frequency, and 3 on breast cancer outcomes.Fig. 2Summary of 75 inequality relationships from 34 articles between a social determinant and review endpoint [40–70, 72, 73]. Legend: Age and limited breastfeeding cells do not separate youth and adult samples as the studies have combined these age groups in their samples
…”
Section: Resultsmentioning
confidence: 99%
“…Summary of 75 inequality relationships from 34 articles between a social determinant and review endpoint [40–70, 72, 73]. Legend: Age and limited breastfeeding cells do not separate youth and adult samples as the studies have combined these age groups in their samples…”
BackgroundBreast cancer is the leading cause of cancer deaths among women in the Caribbean and accounts for >1 million disability adjusted life years. Little is known about the social inequalities of this disease in the Caribbean. In support of the Rio Political Declaration on addressing health inequities, this article presents a systematic review of evidence on the distribution, by social determinants, of breast cancer risk factors, frequency, and adverse outcomes in Caribbean women.MethodsMEDLINE, EMBASE, SciELO, CINAHL, CUMED, LILACS, and IBECS were searched for observational studies reporting associations between social determinants and breast cancer risk factors, frequency, or outcomes. Based on the PROGRESS-plus checklist, we considered 8 social determinant groups for 14 breast cancer endpoints, which totalled to 189 possible ways (‘relationship groups’) to explore the role of social determinants on breast cancer. Studies with >50 participants conducted in Caribbean territories between 2004 and 2014 were eligible for inclusion. The review was conducted according to STROBE and PRISMA guidelines and results were planned as a narrative synthesis, with meta-analysis if possible.ResultsThirty-four articles were included from 5,190 screened citations. From these included studies, 75 inequality relationships were reported examining 30 distinct relationship groups, leaving 84% of relationship groups unexplored. Most inequality relationships were reported for risk factors, particularly alcohol and overweight/obesity which generally showed a positive relationship with indicators of lower socioeconomic position. Evidence for breast cancer frequency and outcomes was scarce. Unmarried women tended to have a higher likelihood of being diagnosed with breast cancer when compared to married women. While no association was observed between breast cancer frequency and ethnicity, mortality from breast cancer was shown to be slightly higher among Asian-Indian compared to African-descent populations in Trinidad (OR 1.2, 95% CI 1.1–1.4) and Guyana (OR 1.3, 95% CI 1.0–1.6).ConclusionStudy quantity, quality, and variability in outcomes and reporting limited the synthesis of evidence on the role of social determinants on breast cancer in the Caribbean. This report represents important current evidence on the region, and can guide future research priorities for better describing and understanding of Caribbean breast cancer inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-017-0540-z) contains supplementary material, which is available to authorized users.
“…33 Analyses of data, issuing from these AC3 collaborations, have been conducted or are near completion for prostate, breast, and head and neck cancers. 34–39 Such findings have helped shed insight into the burden of cancer and differences in outcomes in comparison with US or global cancer statistics. Furthermore, the important role played by cancer registries, in terms of research or public health intervention, was illustrated by the French Caribbean island of Martinique.…”
Background
Few national registries exist in the Caribbean, resulting in limited cancer statistics being available for the region. Therefore, estimates are frequently based on the extrapolation of mortality data submitted to the World Health Organization. Thus, regional cancer surveillance and research need promoting, and their synergy must be strengthened. However, differences between countries outweigh similarities, hampering registration and availability of data.
Methods
The African-Caribbean Cancer Consortium (AC3) is a broad-based resource for education, training, and research on all aspects of cancer in populations of African descent. The AC3 focuses on capacity building in cancer registration in the Caribbean through special topics, training sessions, and biannual meetings. We review the results from selected AC3 workshops, including an inventory of established cancer registries in the Caribbean region, current cancer surveillance statistics, and a review of data quality. We then describe the potential for cancer research surveillance activities and the role of policymakers.
Results
Twelve of 30 Caribbean nations have cancer registries. Four of these nations provide high-quality incidence data, thus covering 14.4% of the population; therefore, regional estimates are challenging. Existing research and registry collaborations must pave the way and are facilitated by organizations like the AC3.
Conclusions
Improved coverage for cancer registrations could help advance health policy through targeted research. Capacity building, resource optimization, collaboration, and communication between cancer surveillance and research teams are key to obtaining robust and complete data in the Caribbean.
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